Q&A With Jay Krueger: Evaluating Medical Marijuana Policies

Q: When it comes to chronic pain treatment, you advise that workers comp insurers and employers should carefully evaluate their position on medical marijuana and draft appropriate policies on coverage of medical pot. Why is that important for them to do today?

There is a lot of research under way on the use of medical marijuana in the treatment of pain. Given its federally illegal status and the fact that certain states have legalized medical marijuana at the state levels, pharmacy benefit managers/insurers/employers need to have a procedure or policy in place to deal with the use of this substance. There may be instances where an injured worker may approach a pharmacy with a request for medical marijuana, or an employee may come to work under the influence of medical marijuana in a state where it is legalized. Companies must have a plan in place to indicate how they will deal with these situations to avoid legal action.

Q: Is the search today for treatments that might help chronic pain sufferers—including employees suffering from work-related injuries—find relief, among issues that could bring this subject into the work comp industry?

Definitely. Patients are always looking for the next new treatment for their pain, particularly when no other agent has been able to provide effective pain relief. Regardless of the cause, industrial or not, pain is pain, and the need to effectively manage it is the driving force in finding new analgesic strategies.

There have been several clinical trials that have found statistically significant pain relief in patients utilizing medical marijuana vs. placebo. One such randomized, placebo-controlled trial conducted in 2007 with 125 patients indicated that participants utilizing marijuana for medical purposes reported statistically significant reductions in pain scores, as well as improvements in secondary outcome measures of sleep and neuropathic pain symptoms. A similar study conducted in 2008 on 38 patients and published in the Journal of Pain reported that smoking marijuana led to a significant analgesic response while exhibiting minimal psychoactive side effects.

Several studies are in the process of being conducted regarding the use of marijuana (or marijuana components) for the treatment of pain, and we may see more results supporting this as a viable treatment option.

It's possible that we'll see more synthetic marijuana preparations than the actual use of smoking home-grown marijuana. Use in this manner can be regulated more easily and quality can be assured more readily. Furthermore, a physician cannot legally "prescribe" medical marijuana as it is not an FDA-approved medication.

Any prescription for this substance would be considered invalid and is not legally viewed as a legitimate prescription. A synthetically manufactured FDA-approved product however, could be legitimately prescribed.

Q: What are barriers you suspect will delay or stop medical marijuana from becoming a workers' comp issue?

Although some states have legalized the use of medical marijuana, it still remains illegal at the federal level, and therefore is not viewed as a legitimate medication. Additionally, the potential for misuse of medical marijuana for nonmedical purposes is high and the possibility of functional impairment is a concern as it is not conducive to a return-to-work situation. However, synthetic preparations (pharmaceutically manufactured) marijuana generally only contain the active ingredient and would not be as likely to lead to the euphoric effects normally associated with smoking marijuana.

Finally, due to its federally illegal status, there is no carefully regulated manufacturing process. In general, medical marijuana is cultivated by individual growers with no oversight into purity, content or strength. The medical community is more likely to experience barriers to acceptance for medical marijuana if legalization occurs for smoking home-grown product vs. a synthetic version, generated by pharmaceutical manufacturers.

The medical community (and the federal government) is more likely to view a synthetic, FDA-approved marijuana substance as a legitimate pain-management option vs. home-grown marijuana which is not held to the same standards for purity, quality, etc.

For example, Marinol is currently an FDA-approved synthetic preparation of delta-9-tetrahydrocannabinol, one of the 66 active compounds in marijuana, which is approved for the treatment of anorexia and nausea/vomiting. Given its FDA approval status, clinical assurance is granted to the end-user and the medical community regarding the mitigation of the abuse/euphoric effect that is possible with home-grown marijuana, while ensuring that stringent manufacturing processes have been met.

By focusing clinical efforts at identifying and manufacturing marijuana-based products that specifically address pain, the workers compensation industry may be more likely to view such a product as a legitimate treatment option.

Currently, there are a number of clinical trials under way evaluating the effect of delta-9-THC, and other marijuana constituents for the treatment of pain. These trials may one day lead to the FDA-approval of marijuana-based products which are specifically approved and manufactured for the treatment of pain.